Category Archives: blog

Good in Bed: Getting back in sexual sync

featured, Sexual Health

Good in Bed: Getting back in sexual sync

2011-06-16

With an estimated 40 million Americans stuck in sexless marriages, mismatched libidos could be the No. 1 sex-related issue facing couples in long-term relationships.

Generally, at the start of a relationship, the thrill of infatuation keeps us sexually motivated – the whole “can’t keep your hands off of each other” phase – but once we settle into a sense of routine, gaps in libido that may have previously been masked become revealed. Sex drive is very individual, and no two people can reasonably expect to always be in sync over the course of a long-term relationship, regardless of their love for each other.

Mismatched libidos are so common partly because our individual sex drives interconnect with so many other aspects of our lives, and numerous factors can lead one or both partners to experience diminished desire at one point or another. If you stay in a relationship long enough, it’s almost guaranteed that at some point you’ll be dealing with one or more of these issues and that your libido or your partner’s will change:

– Stress, depression, and anxiety
– Age, health, and medical treatment
– Lifestyle issues such as sleep, exercise, nutrition, and tobacco and alcohol consumption
– Relationship boredom
– Diminishing sexual attraction to one’s partner
– Relationship issues and anger
– Lack of sexual enjoyment during partner sex
– Milestones such as having kids that often test a relationship
– Lack of prioritization of sex

Unlike a general sex rut, in which both partners experience diminished desire, libidos that are starkly mismatched can present a whole new array of problems. When you want sex but your partner doesn’t, the rejection can sting – and highjack your relationship emotionally: Your self-esteem can plummet and an inner rage can seethe.

The ego is extremely frail when it comes to sex, and even being rejected once or twice can lead you to give up altogether. On the other hand, if you’re not feeling in the mood, even a hug or a kiss can feel like a sexual overture and create a sense of sexual pressure. Mismatched libidos can be complex, so it’s worth seeking out a therapist or counselor to help cope with them, especially if the problem has been going on for a while. In the meantime you can visit one of our experts in our forum at Good in Bed and here are some tips to help you get in sync:

– If you’re in a relationship in which non-sexual physical intimacy has dried up to the point where any gesture of intimacy comes off as an overture to have sex, it’s probably a sign that you need to cultivate more non-physical intimacy in your relationship. Recent research shows that kissing is paramount to men’s sexual satisfaction, according to researcher Debby Herbenick, Ph.D. Men who report engaging in more kissing, cuddling, and touching with their partners tend to be more sexually satisfied in their marriages. If sex is like a plant and easily prone to withering, then non-physical intimacy is a vital nutrient, like the sun. Create a zone in your relationship where you can be physical and affectionate without the pressure of those activities leading to sex.

– Don’t give up on sex, especially if you’re the partner with a higher libido. I offer this advice a lot to new parents, especially dads who often find themselves feeling like a third wheel or who are frustrated that their wives are so disinterested in sex. It’s easy to turn off and tune out, and many new parents have gone months, even a year or more, without having sex. But a couple has to restore intimacy, which often requires the patience and loving persistence of the higher-desire partner. Life is full of ebbs and flows, and common milestones—like having kids—can transform a relationship and often one’s sex life.

– Communicate about the issue, figure out what’s going on, and come up with a plan. Usually the issue just goes unacknowledged too long, leading to a sense of silent desperation. But relationships come with lots of difficult conversations – about money, kids, in-laws – and talking about sex shouldn’t be swept under the rug, either. When sex drive disappears (from an individual or a relationship), it’s generally a sign that something else is going on. Sex is a clue and a motivation to get to the bottom of the problem.

– Make the conversation sexy. It takes more than just constructive communication to get in the mood. That’s why so many sex therapists and counselors give their patients homework. The brain is the biggest sex organ, so find something sexy to say about your partner, share a fantasy, do something that is simultaneously sexy and boosts your partner’s self-esteem.

– Enjoy your sexuality on your own. Masturbation isn’t a substitute for the thrill and sensuality of skin-on-skin partner sex, but if you’re the higher-desire partner it can help take the edge off and fill natural gaps in libido. For lower-desire partners, just because you have less interest in sex with your partner that doesn’t mean you can’t or shouldn’t enjoy your own sexuality. Sometimes masturbation can provide a sexual jumpstart.

– Pay attention to how you handle the issue. When a little dry spell starts to become a permanent rut, we usually deal with it in one of two ways: lashing out and being mean, or holding a grudge and acting like everything’s fine. Neither option is healthy. Left unattended, mismatched libidos can create issues that spiral out of control and lead to unfortunate consequences, such as infidelity.

– Last of all, have sex. Try it – you’ll like it (we hope). This is especially true if you’re the type of person that wants to want sex, but just doesn’t. Sometimes you have to put your body through the motions and wait for your mind to follow.

If, despite these tips, you really feel like your libidos are irreconcilably mismatched, see a professional. Visit the website for the American Association of Sexuality Educators, Counselors, and Therapists at aasect.org to find a therapist. With the right care and feeding, your sex life can thrive.

Should Kids Under 13 Be on Facebook?

featured, Uncategorized

Should Kids Under 13 Be on Facebook?

2011-06-14

In a perfect, law-abiding world, no child under 13 has a Facebook account. But this world is pretty far from ideal, if the 7.5 million tweens — and younger kids — trolling the social-media behemoth are any gauge. Now, if Facebook founder Mark Zuckerberg gets his way, that already impressive number will explode.

Last week, Zuckerberg told the NewSchools Venture Fund’s Summit in Burlingame, Calif., that he’d like younger children to be permitted to patronize his site. Technically, the Children’s Online Privacy Protection Act (COPPA) prohibits websites that gather data about users from allowing access to anyone younger than 13. In reality, though, COPPA is pretty ineffectual.

Consumer Reports (CR) recently announced results of an annual survey that found that “more than one-third of the 20 million minors who actively used Facebook in the past year” were under 13.

In fact CR found that over 5 million of Facebook’s 7.5 million-plus underage were as young as “10 and under.” … That’s not the worst of it. CR also found that underage kids using Facebook were unsupervised by parents. The site claims — not wrongly — that this exposes them to “malware or serious threats such as predators or bullies.”

Consider other points raised in the report like: 15% of all Facebook users post “their current location or travel plans,” 34% post their birth date in full, and 21% with children post their children’s names and pictures.

What about Facebook’s privacy controls, your bastion against all things nefarious? CR found “roughly one in five” weren’t using them.

Still Zuckerberg insists that connecting on Facebook — for educational purposes, natch — is a must for young kids. “That will be a fight we take on at some point,” CNNMoney quoted him as saying. “My philosophy is that for education you need to start at a really, really young age.”

(More on Time.com: Pediatricians Should Discuss ‘Facebook Depression’ with Kids)

Zuckerberg, not so far removed from the gawky age of 13 himself, says that Facebook has not begun researching how to open up the site to young kids and protect them at the same time. “Because of the restrictions we haven’t even begun this learning process,” he said. “If they’re lifted, then we’d start to learn what works. We’d take a lot of precautions to make sure that they [younger kids] are safe.”

Whew. That’s reassuring.

Still, it’s undeniable that kids simply don’t have the same powers of judgment as adults. Consider, for example, the New Hampshire teen who mourned on Facebook that Osama bin Laden hadn’t first offed her math teacher before he was killed. “In hindsight, she’s mortified that she said that, but she’s a 13-year-old kid,” the girl’s mother, Kimberly Dell’isola, told a local television station.

That’s exactly why the publisher of Consumer Reports isn’t quite as cavalier as Zuckerberg about little ones friending and tagging to their hearts’ content. On Friday, the nonprofit Consumers Union worried that kids and teens don’t really get why it’s so important to self-censor what they share with the online world. “We urge Facebook to strengthen its efforts to identify and terminate the accounts of users under 13 years of age, and also to implement more effective age-verification methods for users signing up for new accounts,” Ioana Rusu, the regulatory counsel for Consumers Union, wrote in a letter to Zuckerberg.

According to the Los Angeles Times, Rusu’s letter came on the heels of a congressional hearing questioning the security of underage Facebook users:

Senate Commerce Committee Chairman John D. Rockefeller (D-W.Va.) said it was “indefensible” that Facebook had only 100 employees monitoring the activities of its 600 million users.

At the hearing, Facebook Chief Technology Officer Bret Taylor said Facebook shuts down the accounts of people found to be lying about their age. But he acknowledged that Facebook depended on other users to report underage users.

The Consumers Union urged Facebook to be more “diligent and effective” at safeguarding the millions of minors who frequent the site. It suggested a few ways to do that: make minors’ default privacy setting one that facilitates sharing with “friends only” instead of “friends of friends;” for the average user, that amounts to nearly 17,000 people. And institute an “eraser button” that users can click to delete embarrassing information posted on the site when they were underage.

An eraser button? Should it actually be created, many adults will likely lobby to use it too.

Go ahead – ‘sext’ your spouse

featured, Sexual Health

Go ahead – ‘sext’ your spouse

2011-06-10

Is “sexting” really cheating? Well, if, like Congressman Anthony Wiener, you’re married and sexting someone other than your spouse (and without your partner’s knowledge or approval), of course it is!

In an earlier post for The Chart, I talked about Internet infidelity and how it’s accelerating at a record pace. With its easy accessibility and novelty, the Internet enables us to easily tune out and turn off to our partners, when we should be making an effort to tune in and turn on.

The instant gratification of these technologies stimulates reward centers in the brain, and soon we find ourselves craving the quick hit of an instant connection or lamenting its absence.

Real relationships take time and patience, whereas sexting a stranger or engaging in a flirtatious Facebook friendship brings us a quick thrill and requires a lot less work. And the more technology becomes a personal accessory that renders us always on, the more likely we are to become novelty seekers in search of the next ping.

We live in an era when many consider sexual infidelity to be the ultimate personal betrayal. But there are those who believe that if infidelity doesn’t involve a physical component, it’s not really cheating—and that’s just not true.

The accessibility of the Internet means that we need to be more vigilant of emotional infidelity, and seemingly benign activities that nonetheless have a sexual and secretive component.

In her seminal book on emotional infidelity, “Not Just Friends,” the late psychotherapist Shirley Glass implores readers to “maintain appropriate walls and windows. Keep the windows open at home. Put up privacy walls with others who could threaten your marriage.” She contends than an emotional affair is marked by three distinguishing qualities:

– Close friendship and emotional intimacy. An emotional affair often begins as friendship and gradually drifts into something more. While friendship alone isn’t enough to qualify as cheating, a feeling of shared closeness and understanding is the starting point for an emotional affair.

– Sexual attraction. An emotional affair is fueled by feelings of attraction between two people.

– Secrecy. Here’s where friendship and attraction cross the line into emotional cheating. In an emotional affair, each person stops sharing certain aspects of the friendship with his or her partner, and starts confiding more in the “friend” and less in his or her partner.

We’re all living, breathing sexual beings. Attraction doesn’t end once we’re in a relationship. Even the most happily coupled people are going to feel the familiar buzz of attraction when someone catches their eye or laughs at one of their jokes. And as I discussed in another column for The Chart on negotiated monogamy, some couples are even willing to expand the boundaries of flirtation and accepted behavior within their relationship.

Relationships often start out in the “fast lane,” but eventually we find a comfortable cruising speed in the middle lane, and sometimes switch over to the slow lane.

Some relationships run out of fuel altogether, and every couple needs a jump-start every now and then. Instead of seeking that jolt of excitement from outside your relationship, make more of an effort to seek it within.

Beware the sleeping pill hangover

Psycological Health

Beware the sleeping pill hangover

2011-06-08

Henry was 80 years old and “tired all the time.” His primary care doc had done a thorough work up. I tested for every sleep disorder known to man and god and found no underlying problem with his sleep quality.

At our initial visit, I had expressed my concern that his hypnotic medication, Clonazepam, could be part of the problem, especially because his dose of 2 mg was rather high for a man his age. He had been reluctant to make any changes to a medication that, from his point of view, had worked so well for him over the years. Now, with all other explanations ruled out, he was ready to try to get off it in order to feel less groggy in the morning.

I tapered him slowly and he had no withdrawal symptoms nor any rebound insomnia. He feels more energetic and less sleepy in the daytime and he only occasionally uses a sleeping aid when he has trouble falling asleep.

This is a scenario that is played out every day in my sleep clinic: the medications that we doctors give to help patients sleep end up making them feel tired and groggy the next day.

Clonazepam (Klonopin) is a common culprit. It belongs to a class of drugs called benzodiazepines. They have been used as sleeping agents for decades. They have many other uses including the treatment of anxiety, seizure and muscle spasm.

In general, these drugs can be very useful sleep aids, but must be used cautiously because they will often cause dependence, tolerance, withdrawal and rebound insomnia if used long enough on a nightly basis. Dependence is fairly self-explanatory and means that a person cannot sleep without the drug. Tolerance means that that the dosage has to be repeatedly increased to achieve the same affect. It is not the same as addiction but is often confused with it.

They can also cause withdrawal which means the emergence of a new set of symptoms that were not present before using the medication. Common withdrawal symptoms include agitation, nausea, sweating and palpitations.

The benzodiazepines can cause rebound insomnia. Rebound insomnia means insomnia that is worse than it was before a patient started the drug. Typically, it lasts only one or two nights.

The problem with Clonazepam in particular is that it has a very long half life. Therefore, it takes a long time to clear the system and its hypnotic and sedating effects can last well into the next day. There can be withdrawal if stopped abruptly, but it is less likely to cause rebound insomnia when compared to shorter-acting benzos.

Besides daytime sedation, any of the benzodiazepines can cause amnesia, sleepwalking and sleep eating. There are studies showing increased fall risk in the elderly, but there is also research showing that untreated insomnia increases falls. There is definite concern that these medications can have multiple deleterious effects in the elderly including memory and cognition problems. As with most medications, the doses should be lower when patients are elderly or have liver or kidney impairment.

For insomnia treatment, it is better to use benzodiazepines that have a medium half life such as lorazepam or temazepam. They will usually help someone get to sleep and stay asleep most of the night without too much hangover effect the next morning.

As with most prescription sleep aids, I recommend intermittent use so that tolerance and withdrawal might be avoided.

Medications such as zolpidem (Ambien) are called non-benzodiazepines but that is misleading because they act on the same GABA benzodiazepine receptors in the brain. They just don’t bind to as many subunits as the traditional benzos which has good and bad effects. One bad effect is that drugs like Ambien have no anti-anxiety properties and most people with insomnia have anxiety either that is fueling the insomnia or as a consequence of the insomnia.

Therefore, if someone has chronic, nightly difficulty falling asleep or staying asleep, I recommend CBT-I (cognitive behavioral therapy for insomnia). As I have discussed in previous posts, it is the safest treatment and actually the most effective one in the long term.

Warning signs of pregnancy-related diabetes

Reproductive Health

Warning signs of pregnancy-related diabetes

2011-05-30

Diabetes stemming from pregnancy can cause a host of problems for baby and mother alike, including birth complications and a higher risk of developing the more serious type 2 diabetes later in life.

In a new study, researchers say they’ve identified a series of routine health measures that can help doctors predict years in advance which women will develop pregnancy-related diabetes, paving the way for lifestyle changes and other early prevention efforts. Continue reading Warning signs of pregnancy-related diabetes →

Irregular periods in teens linked to health risks: study

Reproductive Health

Irregular periods in teens linked to health risks: study

2011-05-27

Teenagers who have irregular periods are more likely to be overweight and obese and to have early warning signs of diabetes and heart disease than those with regular menstrual cycles, a study said.

While the link between irregular periods and heart disease and diabetes is well-established in older women, the findings, published in “Fertility and Sterility,” suggest that doctors might be able to identify this risk much earlier — and try to do something about it. Continue reading Irregular periods in teens linked to health risks: study →

Menopause age related to when mom went through it

Reproductive Health

Menopause age related to when mom went through it

The age at which women go through menopause depends a lot on when their relatives did, according to new study findings.

Specifically, women whose mothers or sisters experienced menopause by age 45 were roughly 6 times more likely to do the same. Women who underwent menopause at a relatively late age – 54 or older – were also 6 times more likely to have seen the same thing happen to their mothers, and twice as likely to see it in their sisters. Continue reading Menopause age related to when mom went through it →

Why your brain needs vacations

Psycological Health

Why your brain needs vacations

2011-05-25

Mary Kole loves her job, but she’s been feeling like she’s lost the line between “work” and “not work.”

A literary agent for children’s books in Brooklyn, New York, Kole works from home and checks in with clients electronically around the clock — sometimes writers will even call her in the middle of the night with an idea. Stepping outside isn’t exactly relaxing either. “In New York, it’s just subway, office, people, talking, yelling, honking, all the time,” she said. Continue reading Why your brain needs vacations →

1 Million Kids With Asthma Wrongly Prescribed Antibiotics Yearly

Uncategorized

1 Million Kids With Asthma Wrongly Prescribed Antibiotics Yearly

When should doctors prescribe antibiotics to treat asthma? “The answer in 2011 is that they shouldn’t,” says Ian M. Paul, M.D., associate professor of pediatrics at the College of Medicine at Penn. State. Yet Paul and his colleagues have found that doctors do – about a million times a year.

Their study, published online May 23 and in print in the June issue of Pediatrics, looked at more than 60 million cases where children across the U.S. visited their doctors or the emergency room for asthma treatment from 1998 to 2007. They found that antibiotics were prescribed inappropriately at as many as 1 in 6 of these visits.

Healthcare experts have long been concerned about the over-prescribing of antibiotics because it can lead to the evolution of bacteria that is antibiotic resistant. The only time children with asthma should receive antibiotics is if they have an additional diagnosis – maybe a bacterial infection such as pneumonia – where the drugs would be needed.

Based on this study, researchers couldn’t determine why exactly doctors ignore guidelines and prescribe antibiotics for asthma. But they did note that children who received systemic corticosteroids (indicating a more severe attack) to treat their asthma were also more likely to receive antibiotics. “I can surmise from that that those kids were sicker, and the doctor wanted to throw the kitchen sink at it,” says Paul. Also, because asthma and pneumonia share some signs and symptoms, it is possible doctors prescribe antibiotics when they aren’t certain of their diagnosis.

Surprisingly to Paul, this is less likely to happen in emergency departments than at the doctor’s office, though the study offers no clues as to why. But in either type of visit, discussion with the doctor is key. “We found that when the doctors spent the time to educate families about asthma, they were 50% less likely to prescribe antibiotics,” Paul says. So parents should ask a doctor prescribing antibiotics to their asthmatic child what the medication is supposed to treat. If the doctor seems uncertain about the diagnosis, it’s reasonable to ask about a 24-hour waiting period to see whether asthma medications help with your child’s symptoms. “It’s really about communication with your doctor,” Paul says. Either way, ultimately, you’ve got to trust your doctor, so make sure your doctor is someone you trust.

Post-baby weight gain raises diabetes risk in next pregnancy

featured, Reproductive Health

Post-baby weight gain raises diabetes risk in next pregnancy

2011-05-24

Women who gain weight after giving birth for the first time dramatically increase their risk of developing pregnancy-related diabetes during their second pregnancy, a new study suggests.

Compared with women of similar height who maintain their weight, a 5-foot-4 woman who gains roughly 12 to 17 pounds after giving birth more than doubles her odds of developing diabetes during her second pregnancy, the study found. If she gains 18 pounds or more, she more than triples her odds.

(The study used body mass index, a ratio of height to weight, so problematic weight gain will vary according to a woman’s height.)

Diabetes diagnosed during pregnancy, known as gestational diabetes, is influenced by hormonal changes and normal weight gain and usually goes away after the baby is born.

It can lead to birth complications, however, and it also increases a woman’s risk of developing type 2 diabetes later in life. In addition, it makes the baby more prone to diabetes and obesity as he grows up.

The findings underscore how important it is for women to lose their baby weight and keep postpartum weight gain to a minimum, the researchers say. This applies especially to those who are overweight or obese at the start of their first pregnancy.

The overweight women in the study who lost weight post-birth substantially lowered their risk of gestational diabetes compared with those who maintained their weight.

“We acknowledge that this is not an easy thing to do,” says the lead author of the study, Samantha F. Ehrlich, a researcher at Kaiser Permanente, in Oakland, California. “It’s quite common for women to gain weight.”

The study, which appears in the June issue of the journal Obstetrics & Gynecology, included 22,351 ethnically diverse women who were members of the Kaiser Permanente health plan in Northern California. The overall rate of gestational diabetes during the women’s first pregnancy was 4.6%, and during the second it was 5.2%.

Less than 10% of the women in the study lost weight between pregnancies, which isn’t surprising given the new stresses and responsibilities that come with a newborn.

Having a baby causes a host of changes to a mother’s life and lifestyle that can influence her eating patterns, exercise habits, and work-family balance, says Truls Ostbye, M.D., a professor at Duke University Medical Center, in Durham, North Carolina, who studies postpartum obesity but was not involved in the current research.

“Many of these changes make it hard to return to a healthy weight,” he says. “But the period can also be seen as a teachable moment for positive change. [It] can be time when the mother — and the rest of the family — can refocus on a healthy lifestyle and set the new baby on a lifelong healthy trajectory.”

Pregnant women should walk regularly (with or without a stroller), keep snacking to a minimum, and avoid soda and other sugary drinks, Ostbye says. Breast-feeding can also make it easier for women to shed pregnancy pounds.

Women who breast-feed their babies for at least six months are more likely to achieve a healthy weight after pregnancy, Ostbye adds. Ehrlich and her colleagues are currently studying a weight-loss program, which includes weekly telephone coaching sessions, specifically tailored to help women with infants exercise and eat well.

“We believe that something that’s based on the telephone or a website would be easier for new moms to do than having to go somewhere to have classes,” she says.